Abstract
BackgroundSepsis is a severe condition associated with high prevalence and mortality rates. Parvovirus enteritis is a predisposing factor for sepsis, as it promotes intestinal bacterial translocation and severe immunosuppression. This makes dogs infected by parvovirus a suitable study population as far as sepsis is concerned. The main objective of the present study was to evaluate the differences between two sets of SIRS (Systemic Inflammatory Response Syndrome) criteria in outcome prediction: SIRS 1991 and SIRS 2001. The possibility of stratifying and classifying septic dogs was assessed using a proposed animal adapted PIRO (Predisposition, Infection, Response and Organ dysfunction) scoring system.ResultsThe 72 dogs enrolled in this study were scored for each of the PIRO elements, except for Infection, as all were considered to have the same infection score, and subjected to two sets of SIRS criteria, in order to measure their correlation with the outcome.Concerning SIRS criteria, it was found that the proposed alterations on SIRS 2001 (capillary refill time or mucous membrane colour alteration) were significantly associated with the outcome (OR = 4.09, p < 0.05), contrasting with the 1991 SIRS criteria (p = 0.352) that did not correlate with the outcome. No significant statistical association was found between Predisposition (p = 1), Response (p = 0.1135), Organ dysfunction (p = 0.1135), total PIRO score (p = 0.093) and outcome. To explore the possibility of using the SIRS criteria as a fast decision-making tool, a Fast-and-Frugal tree (FFT) was created with a sensitivity of 92% and a specificity of 29%.ConclusionThese results suggest that increasing the SIRS criteria specificity may improve their prognostic value and their clinical usefulness. In order to improve the proposed PIRO scoring system outcome prediction ability, more specific criteria should be added, mainly inflammatory and organ dysfunction biomarkers.
Highlights
Sepsis is a severe condition associated with high prevalence and mortality rates
The target population included dogs hospitalized in the Infectious Disease Isolation Unit (IDIU) from November 2013 until June 2019, with a positive laboratory diagnosis of canine parvovirosis either by ELISA or PCR faecal antigen detection, with clinical exam, haemogram, biochemistry records and known outcome, discharge or death
None of the animals included showed signs of cardiovascular or respiratory dysfunction. Since it was first adapted for veterinary medicine, systemic inflammatory response syndrome (SIRS) has been widely used by clinicians and researchers to diagnose sepsis in animals
Summary
Parvovirus enteritis is a predisposing factor for sepsis, as it promotes intestinal bacterial translocation and severe immunosuppression This makes dogs infected by parvovirus a suitable study population as far as sepsis is concerned. When the circulatory and cellular/metabolic abnormalities are severe enough to increase mortality, septic shock should be considered [1]. This translates into a sepsis associated hypotension non-responsive to intravascular volume expansion, that is, dogs with systolic blood pressure < 90 mmHg or mean arterial pressure < 70 mmHg that only respond to vasopressor therapy [2]. During sepsis MODS can be considered when at least two organ systems, distant from the infection site, become dysfunctional [2]
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